How Does Metoprolol Compare to Atenolol?
Key takeaways:
The medications metoprolol and atenolol are beta blockers. They’re prescribed for several heart conditions, but usually they’re not first-choice options for treating high blood pressure.
They both have similar side effects. They lower heart rate and blood pressure, so they can cause dizziness and fatigue.
Metoprolol and atenolol are both available as low-cost generics. You can find them for less than $10 at certain pharmacies with a free GoodRx discount.
Metoprolol and atenolol are some of the most popular heart medications. These medications can treat conditions like coronary artery disease and heart failure. But they can also be used to treat high blood pressure (hypertension).
Metoprolol and atenolol are very similar in terms of how they work and their side effects. But there are some important differences in when they’re prescribed. We’ll compare metoprolol and atenolol and how they’re used for hypertension.
What are metoprolol and atenolol used for?
Metoprolol and atenolol are both beta blockers. These medications work by preventing the heart rate from going too high. This allows the heart to fill up with more blood between each beat and pump more efficiently. It also improves blood flow to the heart, which is important if you have a history of heart disease.
Metoprolol and atenolol are FDA approved to treat:
Chest pain (angina) that happens when the heart isn’t getting enough oxygen
Blood flow to the heart after a heart attack
Heart failure
High blood pressure (but they aren’t usually first-choice medications for this)
Metoprolol comes in two forms: immediate release and extended release (ER). Atenolol only has one release form. All three are available as generic and brand-name medications:
Metoprolol immediate release: Lopressor
Metoprolol ER: Toprol XL
Atenolol: Tenormin
Is metoprolol or atenolol better for hypertension?
Both metoprolol and atenolol can lower blood pressure, but they aren’t interchangeable. When it comes to choosing between metoprolol or atenolol to treat high blood pressure, it really comes down to what else is going on in the body.
Metoprolol is a good option for hypertension if you also have one of these conditions:
Chest pain from decreased oxygen supply to the heart
A history of a heart attack or coronary artery heart disease
A fast or irregular heartbeat, like atrial fibrillation
Heart failure, when the heart does not pump blood as well as it should
In fact, metoprolol ER is proven to improve symptoms of heart failure, lower the risk of death from heart failure, and lower the risk of hospitalization due to heart problems.
Atenolol has not been proven to have these additional benefits for people with heart disease. But it can still help to lower blood pressure. It’s often used as an add-on medication if first-choice hypertension medications alone are not enough.
How do you take metoprolol and atenolol?
The immediate-release form of metoprolol is short acting and needs to be taken twice daily. The extended-release form is long-acting and can be taken once a day. Atenolol is taken once a day.
Dosing for metoprolol and atenolol will depend on your other health conditions. Typical doses for treating high blood pressure are listed below. Your healthcare provider will usually start with the lowest possible dose and increase it from there if necessary.
If the medication isn’t working well enough or causes bothersome side effects, your provider may adjust your dose or recommend a different medication. If you regularly take metoprolol or atenolol, do not stop taking your medication on your own. This can cause chest pain, a dangerous spike in blood pressure, or even a heart attack. For your safety, your provider needs to gradually cut down your dose over time.
Metoprolol tartrate (immediate release)
To treat high blood pressure, here are the typical doses of metoprolol tartrate (immediate release):
Starting dose: 50 mg twice daily
Usual dose: 100 mg twice daily
Maximum dose: 200 mg twice daily
Metoprolol succinate (extended release)
To treat high blood pressure, here are the typical doses of metoprolol succinate (extended release):
Starting dose: 25 mg to 100 mg once daily
Usual dose: 50 mg to 200 mg once daily
Maximum dose: 400 mg daily
Atenolol
To treat high blood pressure, the typical dose of atenolol is 50 mg to 100 mg once daily.
What are the common side effects of metoprolol and atenolol?
When it comes to side effects, metoprolol and atenolol are pretty similar. Potential side effects include:
Slow heart rate
Low blood pressure
Dizziness
Fatigue
Shortness of breath
Depression
Sexual dysfunction
Diarrhea
Even though these side effects have been reported, some of them are rare. For example, a review of 15 randomized, placebo-controlled clinical trials looked at depression, tiredness, and sexual dysfunction. It included over 35,000 participants and found that beta-blocker use did not increase the risk for depression, and it only slightly increased the risk for tiredness and sexual dysfunction.
Metoprolol and atenolol also have important black box warnings: There is a very real risk of chest pain and even a heart attack if these medications are stopped suddenly. As mentioned above, you should only stop these medications gradually and under the supervision of your provider.
If you have diabetes, it’s important to know that both metoprolol and atenolol can cover up symptoms of low blood sugar, like heart palpitations, fatigue, and shakiness. Low blood sugar can lead to dangerous complications, like confusion, seizures, and loss of consciousness. Talk to your provider about how to prevent and spot low blood sugar before you start taking metoprolol or atenolol.
How much do metoprolol and atenolol cost?
Metoprolol and atenolol are both available as generic medications. And GoodRx can help you save over 70% off the average retail price of the generic versions:
Generic metoprolol tartrate’s price at certain pharmacies is less than $8 with a free GoodRx discount.
Generic metoprolol succinate’s price at certain pharmacies is less than $10 with a free GoodRx discount.
Generic atenolol’s price at certain pharmacies is less than $7 with a free GoodRx discount.
The bottom line
Metoprolol and atenolol are two common beta blockers that can help treat multiple types of heart disease. They’re FDA approved to treat hypertension but usually aren’t first-choice medications for this condition.
Metoprolol can be a good way to lower blood pressure in someone who has coronary artery disease or heart failure. And atenolol can be helpful as an additional medication to get blood pressure under control. If you have any questions about whether metoprolol or atenolol is right for you, your healthcare provider can help.
Why trust our experts?
References
Farzam, K., et al. (2022). Beta blockers. StatPearls.
Hjalmarson, A., et al. (2000). Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure the metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF). JAMA.
